Talk:Back pain

I was notified that my edits that created a new section, "Monitoring response to treatment" (see version https://en.wikipedia.org/w/index.php?title=Back_pain&oldid=1306789873 ) were removed. The message I received was "Please stop. If you continue to add unsourced or poorly sourced content, as you did at Back pain, you may be blocked from editing. Please don't use outdated, low-quality chiropractic sources; instead, use WP:MEDRS for this topic."

The article I cited is on PubMed and in my view is the best source as it is the most recent systematic review of a topic that is no longer actively researched. If preferred, I can instead cite an RCT in JAMA, 2015 (PMID 26461996) that used a MCID of 6 in its design and cited an article from 2001 as opposed to the similar recommendation of the Vianin review that I cited and recommends a range of 4.5 to 10.

I greatly respect WikiPedia's dedication to quality, but this may be a case that rather than removing the edit as its content is reasonable, to instead post on the discussion page whether the edit can be improved and/or add a Disputed section tag. I add a second source (or can switch) the citation and note that while the source is from 2001, it is used to design a high quality RCT in a major journal in 2015 (PMID 26461996). Admittedly, I could have proposed my content on the talk page before posting.

While I cited a PubMed article that is not within Medline, the article that I cited is cited by over 50 articles on Medline (combine PubMed articles citing the article I cited with medline[sb] at PubMed.

Apologies for not including the edit summary.

thanks for your time

Badgettrg (talk) 22:20, 19 August 2025 (UTC)

@Badgettrg: Procedural comment – this is not worded as a formal request for comment (and was also in the wrong place). Have you read WP:RFCBEFORE? Not every content/sourcing dispute needs a full-blown RfC – it might be enough to discuss this issue here with Zefr who reverted your addition of the chiropractic source. ClaudineChionh (she/her · talk · email · global) 00:01, 20 August 2025 (UTC)

Badgettrg - the revert of your edit by Special:Diff/1306791453 was justified because 1) your choice of specifying use of the Oswestry Disability Index (ODI) for monitoring back pain after therapy followed your edit at the ODI article, seeming to promote ODI among many possible methods for assessing back pain; and 2) you used a chiropractic source, which is a non-WP:MEDRS reference and 17 years out of date.

The JAMA source you suggest above is a limited clinical trial, not a MEDRS review. Before reverting your edit, I checked PubMed for reviews of methods for monitoring back pain within the past 5 years, but found no good source among them for justifying the ODI or any one assessment scale.

Further, PubMed is only a search service and does not guarantee the quality of any source. A review of MEDRS will help you choose better sources. Zefr (talk) 03:18, 20 August 2025 (UTC)

I have removed the {{rfc}} tag. Prior to this RfC being raised, the last useful comment on this page was almost six years ago on a completely unrelated matter, which tells me that there has been no attempt to use the suggestions at WP:RFCBEFORE, so there was no need to jump straight for a full-blown thirty-day formal WP:RFC. Also, please note that per WP:RFCCAT, |policy is for discussing changes to the policies and guidelines themselves, not for discussing how to apply them to a specific case. Further, the {{rfc}} template does not recognise a parameter like |content=Remove versus disputing new content. --Redrose64 🌹 (talk) 07:20, 20 August 2025 (UTC)

"chiropractic source, which is a non-WP:MEDRS reference," I suggest not using this statement in debates as there are chiropractic journals within the Medline subset of PubMed - see https://www.ncbi.nlm.nih.gov/nlmcatalog/?term=currentlyindexed+AND+chiropractic. Your medline point is better. Another good list of journals, higher standards than Medline, is https://www.acpjournals.org/journal/aim/acpjc/list-of-journals

I can help you with your lit search: "Oswestry Disability Index back pain questionnaire". The Oswestry is also labeled a Score rather than index, so drop index, etc. There are other synonyms for questionnaire so drop that or add the synonyms. Restrict your search to the Medline component of PubMed to better match MEDRS.

So try at PubMed, "Oswestry Disability"[tiab] AND medline[sb]

But that gets far too many Medline articles on the ODI, so you can restrict to systematic reviews by searching: "systematic review"[Publication Type] AND "Oswestry Disability"[tiab] AND medline[sb]

But still too many ODI articles, so examples of more limited searches are

As one example, try: https://pubmed.ncbi.nlm.nih.gov/?term=%22The+Cochrane+database+of+systematic+reviews%22%5BJournal%5D+AND+%22Oswestry+Disability%22%5Btiab%5D+AND+medline%5Bsb%5D&filter=datesearch.y_10&sort=pubdate&format=abstract&size=200

A second example to use is "Oswestry Disability" AND medline[sb] AND guideline[title] at PubMedCentral. That will lead you to a CDC recommendation (within the MMWR) to use Oswestry. https://pmc.ncbi.nlm.nih.gov/articles/PMC9639433/

Reading this citation also leads to finding that the ARHQ also uses the Oswestry - https://www.ncbi.nlm.nih.gov/books/NBK566506/?term=oswestry

So, for the justification of the ODI in the edit, what about:

<blockquote>

the Oswestry Disability Index, which is used by multiple evidence syntheses experts including the CDC (cite), AHRQ (cite), and the Cochrane Collaboration (cite) for assessing back pain, ...

</blockquote>

Seem ok? We can add the Roland scale if you want, but I prefer not to keep expanding this edit.

Thank you for your thoughts. I think the edit is much better now if we are ok with the added length.

I am not a chiropractor but an academic internist - so no bonding to chiropractic. Fortunately, in this setting we are not discussing chiropractic but are discussing measurement that can be used for any back treatment.

thanks

Badgettrg (talk) 16:05, 20 August 2025 (UTC)

In order of your above points:

1. Chiropractic is pseudoscience, and journals from this field do not meet WP:MEDRS; see flagged unreliable journals; search "chiropractic", including the Journal of Chiropractic Medicine, which you entered as a source. Providing an unreliable source was the main reason your edit was reverted.

2. An easy way to check the MEDLINE status of a source, such as your use of PMID 19646379, is to click on the journal title, giving this result: "not currently indexed" (indicating unreliability).

3. This is a highly cited source comparing the Roland-Morris and ODI methods, concluding "there are no strong reasons to prefer one instrument over the other", and that research on these methods has been mostly of low quality. It's not clear why the ODI should be singled out in the article as the example for assessing pain after therapy.

4. Given that the practice, research and review of pain assessment methods have been inconsistent, there isn't a convincing reason for having a section. It's likely practitioners use their own preference from the many scales available. The simple 0-10 scale may be adequate. We do not need to describe everything.

This is why a MEDRS review comparing several instruments for their use with back pain would be useful. Zefr (talk) 18:28, 20 August 2025 (UTC)

Good thoughts. So, why not a simple sentence along the lines of:

In assessing studies of back pain, the ability of treatments to improve function can be compared with either the Oswestry Disability Index (ODI) or the Roland-Morris Disability Questionnaire (RMDQ). [cite PTJ]

Lets leave a 1-10 NRS out since we are looking at function/disability rather than pain. Or add as a separate sentence for Pain as a separate outcome.

If the edit is this short then using "don't describe everything" principle, lets add the one sentence at the start of the management section, just before the first subfolder, Nonspecific pain

Badgettrg (talk) 20:33, 20 August 2025 (UTC)

I'm inclined not to say anything specifically discussing the ODI and RMDQ. The PTJ review is 9 years old (WP:MEDDATE), and states that studies of the two instruments were generally of low quality, indicating minimal confidence in using either one. Perhaps other editors can weigh in. Zefr (talk) 02:39, 21 August 2025 (UTC)

The ODI and RMDQ are used to assess disability by the Cochrane (2025) and AHRQ (2016) in their reviews (PMIDs 26985522,40139265,). These two groups are about as good as anyone at assessing evidence. While the PTJ article is old, that is only a concern if a better scale for measuring disability is being overlooked. If you want a newer review of options on MEDLINE, lets use PMID 31916001 from 2020. Lets do the short sentence so readers are given the beginnings of a framework to assess the quality of claims of interventions. Perhaps,

"In comparing the benefit of treatments of low back pain, the ability of treatments to reduce pain can be measured with simple pain scales. Reducing disability can be compared with validated questionnaires such as the Oswestry Disability Index (ODI) or the Roland-Morris Disability Questionnaire (RMDQ). [cite Cochrane, AHRQ, and the new scale review 31916001"

The only argument I am seeing to excluding this edit is Wikipedia:What Wikipedia is not#Encyclopedic content, but adding two sentences to let readers know a nuance seems a good effort to me.

I would like to being another editor into this discussion. How is that done? thanks

Badgettrg (talk) 23:34, 31 August 2025 (UTC)